Abstract
Spinal endoscopy has the stigma of being reserved for only a few surgeons who can figure out how to master the steep learning curve and develop clinical practice settings where endoscopic spine surgery can thrive. In essence, endoscopic treatment of herniated discs specifically and nerve root compression in the lumbar spine in general amounts to replacing traditional open spine surgery protocols with spinal endoscopic surgery techniques. In doing so, the endoscopic spine surgeon must be confident that the degenerative spine's common painful problems can be handled with endoscopic spinal surgery techniques with at least comparable clinical results and complication rates. In this review article, the authors illustrate the difficulties and challenges of the endoscopic lumbar decompression procedure. In addition, they shed light on how to master the learning curve by systematically looking at all sides of the problem, ranging from the ergonomic aspects of the endoscopic platform and its instruments, surgical access planning, challenging clinical scenarios, complications, and sequelae, as well as the training gaps after postgraduate residency and fellowship programs.
CONCLUSIONS
Endoscopic spine surgery requires a skill set distinct from what is taught in traditional postgraduate spinal surgery programs. Surgeons who have received training in endoscopic treatment of other body parts and organ systems may have an easier transition to learning spinal endoscopy. More complex clinical cases can be treated with the procedure, increasingly obviating the need for open spine surgery. While there are other translaminar minimally invasive spinal surgery techniques, the endoscopic access and treatment methods offer by far the most direct and least disruptive therapies to treat common painful conditions of degenerative lumbar spine disease.